Obstructive sleep apnea

Question 1

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a common sleep disorder characterised by recurrent episodes of partial or complete upper airway obstruction during sleep, leading to intermittent hypoxia and arousals from sleep. What is the duration that typically defines apnea?

1 - >5 seconds
2 - >10 seconds
3 - >15 seconds
4 - >20 seconds

Answer 1

2 - >10 seconds

Question 2

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a common sleep disorder characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, leading to intermittent hypoxia and arousals from sleep. What is the incidence of this?

1 - 12,500 cases per 100,000
2 - 1250 cases per 100,000
3 - 125 cases per 100,000
4 - 12 cases per 100,000

Answer 2

3 - 125 cases per 100,000

Question 3

At what age does the incidence of Is Obstructive sleep apnoea typically peak?

1 - 60-70
2 - 50-60
3 - 40-50
4 - 30-40

Answer 3

2 - 50-60

Question 4

Is Obstructive sleep apnoea more common in men or women?

Answer 4

• men
• 2:1 ratio

Question 5

Organise how airs enters the lungs?

1 - laryngopharynx
2 - nasopharynx
3 - trachea

Answer 5

2 - nasopharynx
1 - laryngopharynx
3 - trachea

Question 6

Which of the following does NOT typically increases the risk of obstructive sleep apnoea?

1 - obesity
2 - macroglossia (enlarged tongue)
3 - acromegaly (abnormal growth of hands etc, normally growth hormone)
4 - hypothyroidism
5 - amyloidosis
6 - female gender
7 - large tonsils
8 - Marfan’s syndrome
9 - nasal septum defects/polyps

Answer 6

6 - female gender

More likely in men

Question 7

In children, which of the following is the most common cause of obstructive sleep apnoea?

1 - enlarged tonsils ± adenoids
2 - increased BMI
3 - syndromes
4 - central neurological

Answer 7

1 - enlarged tonsils ± adenoids

Question 8

How can obesity increase the risk of obstructive sleep apnoea?

1 - fat infiltrates enter the lungs
2 - fat deposits build up around glottis
3 - weight of fat narrows airways
4 - all of the above

Answer 8

3 - weight of fat narrows airways

Question 9

Why does marfans increase the risk of obstructive sleep apnoea?

1 - tall features stretches airways and makes narrower
2 - connective tissue more likely to collapse
3 - weight of fat narrows airways
4 - all of the above

Answer 9

2 - connective tissue more likely to collapse

Question 10

Why does hypothyroidism increase the risk of obstructive sleep apnoea?

1 - tall features stretches airways and makes narrower
2 - connective tissue more likely to collapse
3 - weight of fat narrows airways
4 - thyroid is typically hypertrophied and narrows airways

Answer 10

4 - thyroid is typically hypertrophied and narrows airways

Question 11

How can amyloidosis increase the risk of obstructive sleep apnoea?

1 - amyloid deposition in airway
2 - connective tissue more likely to collapse
3 - weight of fat narrows airways
4 - thyroid is typically hypertrophied and narrows airways

Answer 11

1 - amyloid deposition in airway

Amyloid deposition in the tongue, submandibular and sublingual glands as well as soft tissues around the neck

Question 12

How can acromegaly increase the risk of obstructive sleep apnoea?

1 - amyloid deposition in airway
2 - enlarged neck circumference
3 - weight of fat narrows airways
4 - thyroid is typically hypertrophied and narrows airways

Answer 12

2 - enlarged neck circumference

Question 13

What is the key feature of why apnea is worse at night?

1 - airways contract and become narrows during night
2 - increased cortisol causing vasodilation of airways
3 - hormones induce muscular relaxation
4 - all of the above

Answer 13

3 - hormones induce muscular relaxation

Question 14

Do patients with obstructive sleep apnoea get a good quality of sleep?

Answer 14

• no

Typically woken by apnea and somnolence (drowsiness or strong desire to fall asleep)

Question 15

Which of the following can obstructive sleep apnoea lead to?

1 - metabolic acidosis
2 - metabolic alkalosis
3 - respiratory acidosis
4 - respiratory alkalosis

Answer 15

3 - respiratory acidosis

Typically this is compensated as interruptions in breathing lead to CO2 retention

Question 16

The risk of all of the following can be increased by obstructive sleep apnoea, EXCEPT which one?

1 - stroke
2 - COPD
3 - hypertension
4 - myocardial infarction

Answer 16

2 - COPD

Children can also experience development issues

Question 17

Which of the following is NOT a common symptom of obstructive sleep apnoea?

1 - snoring
2 - antonyms
3 - episodes of apnea during sleep
4 - fatigue
5 - headaches

Answer 17

2 - antonyms
- this means energetic and awake

Patients typically have somnolence, a state of sleepiness and fatigue

Question 18

Which questionnaire can be used to assess the degree of sleep deprivation in a patient?

1 - Wells score
2 - Epworth Sleepiness Scale
3 - CURB-65
4 - Centor score

Answer 18

2 - Epworth Sleepiness Scale

Question 19

A score greater than what in the Epworth Sleepiness Scale would indicate obstructive sleep apnoea and then require a sleep study?

1 - >2
2 - >7
3 - >11
4 - >15

Answer 19

3 - >11

Question 20

How is the diagnosis of sleep apnea typically made?

1 - endoscopy during sleep
2 - collateral history
3 - sleep study
4 - clinical diagnosis

Answer 20

3 - sleep study

Includes:
- pulse oximetry
- polysomnography (EEG, respiratory airflow, thoraco abdominal movement, snoring and pulse oximetry

More episodes of sleep apnea = more severe form of sleep apnea

Question 21

In children, is a sleep study always performed in children with suspected obstructive sleep apnoea?

Answer 21

• no

May do pulse oximetry overnight.
Multiple desaturations is suggestive of obstructive sleep apnoea

Question 22

Which of the following is NOT a treatment for obstructive sleep apnoea?

1 - weight loss/reduce alcohol
2 - continuous positive airway pressure (CPAP)
3 - intra-oral devices (e.g. mandibular advancement)
4 - medications
5 - DVLA notified if excessive daytime sleepiness

Answer 22

4 - medications

No strong evidence to support the use of medications

Question 23

In children what is a treatment offered that would not typically be offered to adults?

1 - weight loss
2 - continuous positive airway pressure (CPAP)
3 - intra-oral devices (e.g. mandibular advancement)
4 - tonsillectomy ± adenoidectomy

Answer 23

4 - tonsillectomy ± adenoidectomy

Main cause in children

Question 24

Which of the following is the LEAST likely cause of central sleep apnea?

1 - obesity
2 - stroke
3 - opioids
4 - heart failure

Answer 24

1 - obesity

More likely to cause obstructive sleep apnea

Brain doesn’t tell us to breath properly, and heart failure is the most common cause